The Condition of Florida, 2014

Florida is still recovering from the Great Recession. As expected in any recovery period, jobs are coming back, although too few to employ the same percentage of Floridians that had jobs before the recession.

State revenues are increasing now and are expected to climb each year into the foreseeable future. But policymakers have used much of that growth money to provide new tax breaks each legislative session instead of reinvesting in areas of the budget squeezed during the recession years.

Telling points: Florida ranks 49th in the nation in per capita state and local spending for education, but corrections is funded well enough to rank 23rd among the states. And the state ranks 43rd in a recent survey of quality of services for the elderly, disabled and their caregivers. The state ranks very low in other measures of well- being affected by state expenditures, as this report indicates.

> Read the report.

Census Data Show Florida Struggling to Recover from Recession

Florida’s poverty rate remained unchanged in 2013, median household income remained lower than before the Great Recession,and the state’s percentage of residents without health insurance was third-highest in the nation, the U.S. Census Bureau reported this week. The data from the American Community

Survey and Current Population Survey paint a picture of Florida still poorer than it was five years previously, despite the ongoing economic recovery.

> Read the report.

MAGI: The Other Change to Medicaid Eligibility and What It Means to Florida

Starting January 2014, Florida will begin using the concept of Modified Adjusted Gross Income (MAGI) when determining eligibility for its Medicaid and CHIP programs.

More than just a number, MAGI is a new method for counting and calculating income under the Affordable Care Act.

Specifically, MAGI will provide a basis for aligning, simplifying and streamlining eligibility across Medicaid, CHIP, and the Premium Tax Credits and Cost-Sharing Reductions available through the new Health Insurance Marketplace.

The "translation" between the current system and MAGI is not completely straightforward, however. In fact, as a result of the differences between the two systems, some Floridians who are Medicaid-eligible under current rules will become ineligible in 2014, even if nothing about their situation changes. On the other hand, some who are ineligible under current rules will be able to qualify once MAGI is implemented.

> Read the report.

Improving Fiscal Condition Allows Legislature to Address Previous Budget Cuts, Increase Tax Fairness

As legislative committees meet in preparation for the 2014 session that begins in March, lawmakers enjoy a much-improved state budget situation for their construction of a new state budget for the next fiscal year.

This fact provides legislators with the opportunity to take a fresh look at making investments in the future of Florida and assuring that the state's tax system is both fair and sufficient to meet state needs.

Now that the state is again showing a healthy balance of funds that are expected to recur and increase, a top priority should be investing again in the social infrastructure.

> Read the report.

State Estimates of Health Premiums Are Faulty, Misleading Consumers

Starting October 1, 2013, Floridians will be able to purchase private health insurance plans through the new Health Insurance Marketplace created through the federal health reform law.

On July 31, the state entity responsible for regulating health insurance policies released information titled "Individual Monthly Health Insurance Premiums Before and After PPACA."

Unfortunately, the information provides no credible comparison of the impact of health reform on rates.  Its continued use as a basis for official projections is likely to result in direct harm to consumers.

> Read the report.

Uncovering Coverage Opportunities In Health Insurance Marketplace

Beginning October 1, 2013, millions of Floridians who are uninsured - or who are insured but have inadequate or unaffordable coverage - will be able to purchase a health plan through the new Health Insurance Marketplace established by the federal Patient Protection and Affordable Care Act (ACA).

Although a number of details remain unclear about Florida's Marketplace and the specific plan offerings to be made available to consumers there, the bottom line is that many more Floridians will be able to get and keep quality, affordable health insurance coverage than ever before.

> Read the report.

Comparison of Alternatives for Medicaid Expansion

With only two weeks left in the 2013 regular session, the question of whether the Florida Legislature will extend meaningful, affordable health coverage to more than a million very low-income, uninsured Floridians remains unanswered.

What the majority in both the House and Senate have made clear is that they have no plans to support a straightforward expansion of the current Medicaid program. As a result, three different alternatives to "Medicaid expansion" are presently working their way through the legislative process.

However, only one of the three proposals would allow significant numbers of Floridians below the poverty level to get and keep real coverage that would provide sustained access to essential care. That same proposal is also the only one of the three that would enable Florida to draw down up to $51 billion in federal matching funds over the next ten years, rather than allowing taxpayer funding earmarked for Florida to be diverted to benefit other states.

This brief compares the three proposals and their implications for the two key groups of stakeholders affected by the decision: low-income, uninsured Floridians and Florida taxpayers generally.

> Read the report.

Rejection of Medicaid Expansion Would Prove Costly to Businesses

Many of the businesses that anchor the state's service-based, tourist-dependent economy would be placed at a significant competitive disadvantage if Florida rejects Medicaid expansion.

These include, for example, Florida's retail, restaurant and hotel chains.

If Florida expands Medicaid, employers pay no penalty for low-wage workers who enroll in Medicaid.

As a result, a large employer that does not provide meaningful, affordable coverage to its eligible low-wage employees will save $3,000 for each such employee that enrolls in Medicaid instead of using Premium Tax Credits in the Exchange—but only if Florida elects to expand Medicaid.

> Read the report.

Governor's Budget Avoids Gutting Safety Net But Misses Opportunity to Strengthen State

Governor Rick Scott’s proposed 2013–14 budget looks much different than his recommendation of a year ago, when he proposed more than $2 billion in cuts to health and human services (HHS) programs.

This year, the governor’s budget calls for more than a billion dollar increase in the HHS portion of the budget.

The governor’s 2013–14 budget proposal has some serious shortcomings, however.  Of perhaps greatest significance is what is not included, namely any indication of an intent to expand the Medicaid program to cover almost a million uninsured Florida adults under the Affordable Care Act.

> Read the report.

Filling the Coverage Gap for Legal Immigrant Children Remains Appropriate

In 2009, Congress gave states the option to allow legal immigrant children to qualify for Medicaid and the Children's Health Insurance Program (CHIP) without enduring the five-year waiting period that applies to most public assistance programs for immigrants.

During the 2012 regular session, state legislation (SB 1294) was proposed that would have exercised that option in Florida and allowed such children to qualify for coverage through Florida KidCare (which includes children's Medicaid and CHIP). SB 1294 passed unanimously out of its first committee but did not make it to final passage. This legislation (or a closely related proposal) is expected to be considered again during the 2013 session.

State money is available to fund health coverage for legal immigrant children. Investment in coverage of these otherwise uninsured children will draw down an additional $43.1 million in federal funds.

> Read the report.

Political Rhetoric Drives Up Estimates of Medicaid Expansion Cost

The primary claim of those opposed to Medicaid expansion under the Affordable Care Act is that the cost to the state would be prohibitive.

One estimate—produced last month by Florida's Agency for Health Care Administration ($2.1 billion per year)—is three times higher than its own estimate from earlier in the year and four times higher than any of the other estimates. For reasons explained in this brief, that estimate must be dismissed outright. Other state-generated estimates ($741 million, $482 million) are less unreasonable, but still deliberately incorporate assumptions that significantly inflate the cost.

In fact, Medicaid expansion would increase the state's share of the total Medicaid budget by only 2 percent over the 10-year period. After factoring in the savings to the state associated with reductions in uncompensated care, the net (true) cost to the state may very well be negative. Thus, despite efforts to make the burden of Medicaid expansion seem onerous and unsustainable, in fact the opposite is true.

> Read the report.

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The Florida Center for Fiscal and Economic Policy
579 East Call Street
Tallahassee Florida 32301
Phone: 850-325-6480

The mission of the Florida Center for Fiscal and Economic Policy is to conduct independent research, develop new ideas, and advise policymakers on state fiscal and economic policy.  The Center pays particular attention to policy impacts on low- and moderate-income individuals, families and neighborhoods, workers, and small businesses.  The Center works to heighten public awareness of the need to adequately fund programs that improve opportunities, choices, quality of life outcomes, and the economic well-being of all Floridians.

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